A combination of a physiotherapy and cognitive behavioural therapy in the treatment of non-specific chronic lower back pain: A systematic review
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Evidence indicates that the current physiotherapy management of patients with chronic non-specific LBP only offers moderate benefit. Combined treatment programmes, addressing body as well as the mind, shows promising results in developed countries with adequate resources but low evidence in poorly-resourced countries and contexts. This is another gap in the existing knowledge. The study aimed to evaluate the effectiveness of a combined physiotherapy and cognitive-behavioral therapy treatment, compared to physiotherapy alone, in reducing pain, disability, mental health and fear-avoidance behavior, in adults with non-specific low back pain. The systematic review included articles published, in English only, between 1985-2018 (July) in the following databases available at the University of The Western Cape: EbscoHost, BioMedCentral, Cambridge Journals Online, CINAHL, Cochrane Library, Medline (EbscoHost), Medline (Pubmed), Sabinet Reference, SAGE Journals Online, ScienceDirect,SciFinder Scholar, SCOPUS, Wiley Online Library, Springerlink and PubMed.Two reviewers independently evaluated the methodological quality of full text articles, using a critical appraisal tool. Fourteen (14) articles were included based on methodological rigour. Five (5) articles were included in the narrative synthesis and nine (9) articles were included in the meta-analyses. Statistically significant improvements in pain, disability and mental health, in favour of combination therapy for patients with chronic lower back pain were found. A small but statistically significant cumulative effect size for mental health (g = -0.26, Z = -4.49, p <.01) , physical disability (g = -0.27, Z = -5.09, p <.01) and pain (g = -.27, Z = -5.05, p <.01) , in favour of a combination of cognitive behavioural therapy and physiotherapy in patients with chronic lower back pain was found. In addition, a medium but statistically significant cumulative effect size (g = -0.50, Z = -6.95, p <.01), in terms of fear avoidance, was found in favour of the combination therapy. In conclusion, physiotherapy in combination with cognitivebehavioral therapy was more effective than physiotherapy alone, in reducing pain, disability, mental health and fear-avoidance behaviour, in adults with non-specific low back pain. Ethics: Permission for the study was obtained from the university’s Biomedical Research Ethics Committee.